MEDICARE: RUTH ELLEN EVERETT RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	4704195551	MI

General Provider Information

NPI Number	:	1558031955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ELLEN EVERETT RN

Provider Business Mailing Address
First Line	:	9195 FORD RD
Second Line	:
City	:	RIVES JUNCTION
State	:	MI
Zip	:	49277-9620
Country	:	US
Telephone Number	:	517-414-1480
Fax Number	:

Provider Business Practice Location Address
First Line	:	9195 FORD RD
Second Line	:
City	:	RIVES JUNCTION
State	:	MI
Zip	:	49277-9620
Country	:	US
Telephone Number	:	517-414-1480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	09/16/2021

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